A run-in with her old flame Sean and an accident in her new car lead Elliot to the realization that nothing good has happened to her in the three years that she has been at Sacred Heart. This realization drives her to take drastic measures, including a complete makeover, both inside and out, in an attempt to change her luck.
J.D. is feeling left out of his friendship with Turk and gets hurt when Turk is scared of opening up to him.
Finding difficulties training his interns, J.D. asks to Elliot for some help. She tells J.D. about Sean, who gave Elliot great tips based on his dolphin training that fit perfectly for her interns.
Sean is a bit surprised and disturbed to learn about Elliot and J.D.'s history together, but it turns out his anger is really a cover up for his upcoming six month long trip and he doesn't want Elliot to explode.
Dan decides to stay with J.D. for a while after their mom's new fiancé kicks him out, but after spending some quality time with him at the hospital, Dan isn't sure if he likes the cynical person his little brother has become.
A chance meeting in the elevator sparks a new friendship between J.D. and the mysterious Danni whose ongoing dialogue about her ex forces J.D. to talk about his feelings for Elliot.
As J.D.'s relationship with Danni progresses, he and Dr. Cox are forced to spend more time together outside of the hospital, to Perry's great chagrin.
Elliot struggles to find her defining moment after Turk performs his first solo surgery. Dr. Cox deals with the reality of growing older when his back goes out. J.D. finds out that many of the hospital staff don't know the Janitor as he does.
Elliot feels uneasy with the proper terms for sexual organs, especially after performing a pelvic exam; J.D.'s patient refuses to have surgery for prostate cancer.
Carla and Elliot try to help a patient, Maggie, lose her virginity as she prepares to die.
J.D. tries to break-up with Danni, but she beats him to it when she realizes that she will always be second place to Elliot in his heart.
J.D. believes he may have finally found a mentor in Dr. Kevin Casey, a surgeon with obsessive-compulsive disorder, and it turns out that Dr. Cox has always been jealous of the guy.
Elliot finds herself perplexed over a simple procedure that leaves her questioning her career path. She goes to seek Dr. Kevin Casey's advice but becomes frustrated when she learns that the epiphany toilet, which the Janitor secretly installed on the roof, is getting more attention than she is.
Jordan's brother and sister return, but Dr. Cox learns that his brother-in-law Ben hasn't visited a doctor about his cancer in the two years he has been gone traveling the world.
Jordan's friends Allison and Maddie come to town to provide moral support for Jordan after her brother's death – however, their constant presence does not provide any relief to Dr. Cox.
An ever present butterfly prompts the question on what could have happened different as Turk looks for his lucky do-rag for surgery, and Elliot tries to find a lost stuffed animal for a child needing a bone marrow transplant.
J.D. must keep a secret when Carla's "what-if" guy asks her out on a date.
Turk has to confront a young patient of his, when he accidentally cuts a nerve and the boy (who happens to be a concert pianist) loses use of one of his hands.
J.D. hooks up with Danni again, after Sean returns, but he can't forget about his passionate night with Elliot.
Elliot asks Sean to move in with her, which only adds to J.D.'s problems.
J.D. is unsure what to do, when he realizes he made a mistake telling Elliot he loved her.
The big day for Turk and Carla has finally arrived, but a patient holds up Turk.