Turk assists Dr. Miller (Bellamy Young) in taking out a tumor on their 16-year-old patient Brian. Dr. Cox and Dr. Kelso are now competing to get some time with her. Despite Dr. Cox's repeated warnings, Dr. Miller agrees to accompany Kelso to a luncheon. Kelso also asks her to a dinner. She accepts at first, but then tells Kelso and Cox that she is going with someone else. She tells Cox that he isn't any better than Kelso and she'll do whatever she needs to, to advance his career.

Turk makes a mistake during Brian's surgery, lacerating the brachial artery, causing nerve damage and limited use of his right hand. Turk feels especially bad because Brian is a concert pianist. But instead of telling Brian the straight truth, he tells him that there were complications. When he later talks to Carla, she senses that he didn't tell Brian the whole story, so she makes him tell everything.

Elliot continues to miss Sean, who's still in New Zealand. Their only contact is phone conversations. Elliot encounters an unusual love story in her new patient, Mrs. Bell (Portia Dawson). Mr. Bell (Michael Edwin) is significantly shorter than his wife, yet they are completely in love. Mrs. Bell tells Elliot that she chose him because he was always there for her.

Turk realizes that Carla is the one for him because she's always pushing him to do the right thing. He had been delaying mailing their wedding invites, but after she pushes him to tell Brian the truth, he feels more secure in his decision to get married, and he finally mails their wedding invitations.

J.D. and the Janitor end up competing as clowns for the children's ward. Elliot was originally supposed to do it, but she was attending to too many patients.

While watching a movie together at the apartment, Elliot takes her hand and wipes off some of the clown makeup still on J.D.'s face. He brushes her hand away at first, but then looks at her and they start kissing furiously and making their way into the bedroom.

After their moment of passion, she tells him that they slept together because he showed up and filled in for her as the clown. Suddenly, Sean walks through the door into the apartment. He tells her that something in her voice told him that she needed him, even though she didn't ask. They exit together.