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In the opening scene of this episode, Turk shows JD the wedding ring he has bought for Carla. After receiving a slap from JD, Turk confirms he is ready for marriage. Turk tells JD he plans to put the ring into Carla’s champagne later that evening.
At Sacred Heart, Elliot is made to feel uncomfortable by the Todd in the co-ed locker room. It is depicted in a fantasy to be like a burlesque show for the guys.
Back at the apartment, Turk is trying desperately to slip the ring into one of Carla’s drinks, first the champagne and then the coffee. Then, Carla receives an urgent call telling her that her Aunt Marie is dead, and has to leave, accidentally causing her to throw the ring down the drain as she goes.
Back at the hospital, JD learns that one of his favorite patients, Elaine, is back and in need of a heart transplant. JD and Elaine discuss the balance of life, which annoys Dr Cox. Cox asks JD if he thinks that another patient (Mrs Larkin) has an irregular heartbeat. Mrs Larkin is heavily pregnant.
Dr Kelso informs Ted that the office next to his own is about to become vacant.
Meanwhile, Turk is telling JD about the problem with Carla, and puts the ring down next to a young patient (Ralphie). Ralphie eats the ring.
Elliot tells Dr Kelso that she is uncomfortable with the co-ed locker room set-up. Dr Kelso dismisses her concerns. JD lends Janitor a pen.
Dr Cox diagnoses Mrs Larkin with a heart valve defect. Her husband, Steve, takes the news very hard.
Meanwhile Turk is trying to retrieve the ring from Ralphie, by feeding him 6 Bran muffins, then by telling him to imagine men inside him pushing out the ‘dookie’. This is unsuccessful, and just upsets Ralphie.
Mrs Larkin crashes (starts to die), as JD tries to console Steve.
Eliot confronts Dr Kelso about the Locker rooms, this time demanding a female room. Turk is stuck in a meal with no ring, and therefore cannot propose to Carla. Janitor reveals that JD’s pen leaked, and draws a moustache on JD as punishment.
JD sits down and convinces Steve to be braver for his wife, as Eliot finally convinces Dr Kelso to add a female locker room to the hospital.
Elaine is telling JD about the prospect of dying (if she doesn’t get a heart). Meanwhile, just outside, Carla is leaving for Chicago. Turk catches up to her and proposes. Carla’s reply is that she’ll think about it. The episode concludes with Elaine dying, and a big musical scene with all the characters, playing out everyones emotions lyrically.