Dr. Cox starts drinking after his decisions result in the death of three of his patients. The staff tries to cover for him at the hospital, while everyone tries to convince him how inspiring he is for them.

Turk starts his new rotation with orthopedic surgery, but isn't so fond of his attending doctor's touchy-feely methods. Thus, J.D. and the Janitor attempt to help Turk find ways to bond with his new supervisor.

J.D. plans a date with Kim on their night off but Elliot keeps getting in their way. Meanwhile, Elliot throws a baby shower for Carla.Perry and Jordan hand over all of Jack's stuff to Carla. And someone announces a very surprising pregnancy.

J.D. addresses the news that he is going to be a father and Dr. Cox is worried about how his anger is going to impact his offspring. Meanwhile, Carla and Turk prepare for the impending arrival of their new baby. Elliot feels left out because she is childless, while the Janitor wonders if he has wasted his life.

J.D. and Kim start contemplating about their future and their baby's future. Meanwhile, Turk rushes Carla to the hospital after she goes into labor. And Jordan accuses Dr. Cox of not being a more defensive father towards Jack.

After being convinced to go to Tacoma for Kim's first ultrasound, J.D., along with Carla, Elliot, Janitor, Keith and Ted, takes Kelso's new RV on a road trip. Meanwhile, Jordan and Dr. Cox have trouble when Jordan's ultrasound reveals that the baby will need surgery.

Laverne is brain-dead, and her family decides to take her off life support. One by one, the staff say their goodbyes, except Carla, who stoutly refuses to accept what's happening. She consequently finds herself "haunted" by Laverne. Meanwhile, Jordan gives birth, but Dr. Cox doesn't want to tell anyone because he doesn't want his daughter's birthday to always be associated with Laverne's death.

J.D. and Turk go to a medical convention in Phoenix, Arizona, where they run into J.D.'s ex-girlfriend Dr. Kim Briggs, who has a surprise for J.D. Meanwhile at Sacred Heart, the janitor pretends to be the chief of medicine and Dr. Cox starts to put doubts about the wedding into Elliot's mind.

In the season finale, J.D. and Elliot start thinking about their future and if they both made a mistake in not being with each other. The Janitor activates the "Brain Trust" to come up with the perfect wedding gift for Elliot.

Turk tries to assure a worried Carla that their daughter will acknowledge her Latin heritage. Meanwhile the Janitor challenges J.D. to identify everyone in the hospital, when it is discovered that he uses nicknames, because he doesn't know the people's actual names. If J.D. can't name all of them, he must take up the mop for a day. Elsewhere, Dr. Cox realizes that he is lonely without his wife and children.

The Sacred Heart staff has to deal with their inner child, when J.D. and Turk remember their first prank, Dr. Cox has a ten year old Leukemia patient and Dr. Kelso celebrates his birthday.

After a hard day of work, Dr. Cox has the burden to tell his son Jack a good night story, so he disguises his hard day as a fairy tale about the little village Sacred Heartlia with Carla and Turk as the two-headed witch Turla, Elliot as the princess and J.D. as the village idiot.

Other people featuring are the Janitor as the giant, Keith as the prince, Dr. Kelso as the dark lord Oslek, Ted as his hunchback and of course Dr. Cox as the brave knight.

While Turk views an inspiring story on SportsCenter, he comes up with a new procedure which may help a paralyzed teen. Meanwhile, Dr. Cox and the janitor are suffering from romantic problems

J.D. is planning on leaving Sacred Heart but before he goes there are a few things that he wants to do including; getting a hug from Dr. Cox, and learning the Janitor's real name. Elliot is ready for the next step in her and J.D.'s relationship and she begins moving her furniture into J.D.'s apartment.