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.

Meanwhile, J.D. gets stuck with a patient, whose diagnosis he can't quite pin down, and when Dr. Cox denies him any assistance, he looks to Carla and Turk to help him out. While Dr. Cox is busy not helping J.D., he takes the time to make amends with Dr. Kelso.