When a rampaging Dr. Cox suddenly shows up at his door in a strange funk, J.D. sees a possibility of a breakthrough in their relationship - until he learns that Cox loses control in almost an annual rite. Meanwhile, Turk elects to partner with Elliot on a research project so that he can maneuver her back with his buddy J.D., and Carla struggles to fulfill a comatose patient's final request - playing heavy metal music in his room.

J.D. has a patient who's rude to him and the nurses and eventually dies from cancer. J.D. feels awful for not giving him his full attention and worries maybe he could have saved the guy if he was nicer to him. Meanwhile, Elliot is convinced that Dr. Kelso is the one singing a song called "Tuscaloosa Heart" on a tape given to her by a patient who claims he went to college with Bob. And Dr. Cox finds himself trapped in a love square: He's falling in love with Kristen Murphy, his intern, just as his ex-wife reappears demanding sex – and there's also his crush on Carla.