J.D. struggles with decision-making and responsibility now that he is an attending physician, all the while Dr. Cox is testing his skills. And while Elliot is learning the ropes in her new hospital, she still feels more comfortable hanging out at Sacred Heart. Meanwhile, Carla is ready to have a baby, but Turk afraid of moving forward continues to slip her birth control pills.

J.D. questions the bond he has with his interns when Dr. Kelso tells him that inevitably he will begin treating them badly, as it has been throughout history at the hospital. The Janitor further complicates matters by telling J.D. that his interns only laugh at his jokes to suck up to him. Meanwhile, Carla visits Elliot at her new job and inadvertently creates an awkward new nickname for her friend when she tells her colleagues an embarrassing story. Elsewhere, Dr. Cox prevents Turk from warning Jordan about a notorious con man patient (guest star Alexander Chaplin) in hopes that she'll be mortified and quit.

As J.D.'s 30th birthday approaches, he sets out to accomplish one item on his Things to Do By Thirty list: complete a triathlon. Meanwhile, Elliot urges Jake to open up about his wants and needs, but immediately regrets it when he does. Turk lets Carla believe she's responsible for his decision to perform hypnosis surgery, but he's really doing it to impress Dr. Kelso.

When J.D. is asked to introduce Dr. Kelso at an awards dinner, he sets out to discover something good to say about the grouchy doctor. Meanwhile, Dr. Kelso and Dr. Cox each have a patient whom they feel deserves the benefit of a new experimental treatment, but a moral standoff ensues when there is only one open slot in the program. Elsewhere, Carla and Turk try to convince Elliot to let them help her get her old job at Sacred Heart back after they discover that she's been working at a free clinic. All the while, the Janitor taunts J.D. with the made-up game of Jiggly Ball.

Dr. Cox's religious sister Paige (guest star Cheryl Hines) comes to town for her nephew's baptism and challenges her brother's faith. Meanwhile, Turk is finding out just how unsexy baby making can be. It takes a heart to heart with Elliot for him to realize that Carla finds the whole process to be romantic. Elsewhere, J.D. and the Janitor seem to have a budding friendship.

J.D. mistakes an elderly woman's satisfaction of leading a good life as her wish to stop treatment for a fatal illness and the patient in turn chooses to work with Dr. Cox. Meanwhile, Turk and Elliot struggle to find the cause of a patients unexplained yet excruciating body pain and Carla struggles with the uncooperative Sacred Heart staff when she tries to organize the annual group photo.

J.D. is called in to work on his day off and every time he tries to go home, he is pulled into another drama. Turk searches for a heart donor to save a dying patient, and Carla is worried that she doesn't have the courage to become a parent. Meanwhile, Elliot doesn't think she has the brains to lead a question and answer session on a subject she knows little about. All the while the Janitor is trying to make the hospital easier to navigate by painting color-coded lines, including a yellow line, which leads to the exit.

J.D., Turk, Elliot and Carla are asked to recount the past weeks events during and interrogation surrounding the mysterious death of a patient. But Dr. Kelso will find it hard to pin point neglect when he learns that J.D. and Turk were away tracking down a patient to illicit a thank you, and Elliot was traumatized over finding out that her make-out buddy was married and Carla was busy recruiting hospital personal for a group lottery purchase.

J.D. is introduced to quirky Julie Quinn and love is in the air. Worried that J.D. will once again screw up the budding relationship Elliot doles out effective romance advice. Meanwhile, Carla questions Dr.Cox's tough exterior and is convinced that the sarcastic doctor is really a softy. Elsewhere, the Janitor puts together an air band to win a contest.

J.D. becomes annoyed that new girlfriend, Julie, doesn't laugh, but rather tells him when things are funny. Afraid that he is going to screw up yet another relationship, Elliot encourages J.D. to start saying his feelings out loud and Turk tries to use his psychology background to fix the issue. Meanwhile, Carla is upset when the Janitor refers to the new nurse as a hot young Carla, increasing her growing concern that she is too old to conceive.

J.D. is still dealing with his recent break-up and trying not to kill intern Keith, who has become annoyingly perfect. To make matters worse a favorite patient is in a serious coma and each of the staff finds their own way to deal with it. Dr. Cox and the Janitor bond over drinks at the bar and Carla makes it her mission to make the hospital's gym female friendly. Meanwhile Turk suggests that J.D. and Elliot find themselves 'booty calls.'

Dr. Kelso is outraged when he discovers that a bird has been living in Sacred Heart. Citing the spread of infection to be the number one cause of deaths in hospitals, Kelso, orders the Janitor to dispose of it immediately. However, the Janitor likes the bird so much he secretly keeps it as a pet. J.D., annoyed that Elliot is hooking up with Keith, tries to get his intern fired.

J.D. and Dr. Cox grow close as they go through the five stages of grief with their favorite patient, who is declining in health. Meanwhile, Carla forces Turk to go on a string of double dates, one of which includes Elliot and her booty call Keith. And when Dr Kelso runs Ted down with his car, Ted finally gains power over Kelso with a potential lawsuit.

J.D. is sick of how perfect intern Keith is and he's not the only one. As hospital gossip spreads and Elliot's relationship with Keith is revealed, the other interns think he is getting special attention. Meanwhile, seeking some special attention of his own, Dr. Cox boasts about being named The Best Doctor in the City by a local magazine, but Dr. Kelso deflates his ego and assigns him to the most difficult patient in the hospital. Elsewhere, Turk and Carla continue to struggle in their quest for conception.

When Dr. Cox scoffs at reading lines with a patient preparing for a play, J.D. urges Cox and his fellow doctors to do special, unconventional things for their patients, but when J.D. scores a date with a hot babe who loves his hair, he's not sure he can shave his head for a woman undergoing chemo. Turk and Carla attempt to eliminate all the stress in their lives to better their chances of conceiving, but Turk has to compete for a surgical resident spot and Carla loses Dr. Kelso's VIP patient. Meanwhile, Elliot showers new boyfriend Keith with stupid gifts.

Turk accidentally learns that Carla is pregnant before she does, so J.D. convinces Turk to tell the entire hospital staff so they can all surprise Carla with the joyous news. But when Carla confides to Turk that she can't wait for the day when she can personally share her baby news with the world, Turk and J.D. have to quickly figure out how to contain hospital gossip until Carla can make the discovery on her own. Meanwhile, J.D. tricks the Janitor into swallowing a tiny GPS tacking device. Later, when Elliott puts Dr. Cox into an embarrassing situation, he decides to get even with Elliott through Keith and Carla.

J.D. changes his night off so he can hang out more with Turk, but Turk is sad to lose his own personal Turk Night. Meanwhile, Jordan forces Dr. Cox go on a double date with Elliott and Keith. Dr. Kelso asks Carla to cover for him and turn down staff requests while he deals with the death of his dog. Later, when a patient almost dies after giving his brother part of his liver, the gang learns that sometimes they have to do things they might not like for the people they care about.

When J.D.'s underachieving brother Dan returns for a surprise visit, Elliott learns that J.D. has been telling Dan that she's still into him, but when the truth comes out, Dan turns to the Janitor to get back at J.D. As everyone reacts to the pregnancy in different ways, Carla and Turk begin to discuss baby names, and despite his promise to Carla, Turk is unable to keep quiet about their initial choices. After assigning someone else to assist sweaty Teddy with incoming malpractice claim paperwork, Dr. Cox is caught off guard when Dr. Kelso steps in to stick him with the job. Meanwhile, a patient with weight-related problems needs an MRI, but the staff has to come up with a solution when they find he's too big for the machine.

After J.D. helps Turk and Carla turn his old bedroom into a nursery for the baby, he gets the idea to strap a digital camera to his head so his mom can see life through his eyes. But the project is cut short when the Janitor seizes an opportunity to shove J.D. out of the picture for a day. Meanwhile, when mistakes by the interns begin to reflect badly on her, Elliott cracks the whip on her charges and even resorts to using her mother Lilly to lean on Keith for information about his peers. Later, Turk accuses Dr. Cox of not being hip.

While working to stabilize three patients awaiting organ transplants, J.D. resolves to ask Dr. Cox to lunch until he agrees. When he finally chases Dr. Cox to lunch, J.D. runs into annoying former patient Jill Tracy, who unexpectedly teaches him something about responsibility. Later, Elliot and Carla discover that Todd's been lying about all his hospital conquests and suspect that he's been less than truthful about other issues, but Turk warns them not to meddle.

Dr. Cox turns to drinking and doesn't show up in the hospital after he made a decision that results in the death of three patients.

For J.D. things seem to be on repeat after the five yers in the hospital. After his alcohol excess Dr. Cox seem to be unsure about ordering treatments for his patients. Carla gets annoyed by Turk telling her stuff she can't do because of her pregnancy.

J.D. is consulting an urologist about a possibly upcoming surgical procedure on one of his patients. Elliot considers a breakup with Keith, because have any grit, especially when Dr. Cox is takes up on him.

J.D. prepares for a perfect date with his new flame, Kim. The hospital staff discusses about a name for Turk and Carla's baby and is surprised that also somebody else is expecting a baby.