Elliot and Molly make plans to go to Karaoke later on. Dr. Cox tells J.D.'s residents that they are at some point they will screw up and kill a patient. J.D. tells Turk and Carla is mad about Roudy being around the apartment all the time. J.D. tells the wheelchair bound Mrs Carter that she is dispatched. Carla discusses the Roudy situation with Elliot and Molly and they suggest doing something nice to him to make Turk happy. Elliot's patient, Mr. Phillips, used to be a drug addict but has been clean for the last 6 months. J.D.'s patient Mr. Daniels needs to have periocardiocentesis and J.D. complains to Dr. Cox about the speech he gave his residents earlier. J.D. takes notice that he has never killed anyone before. The Janitor offers Carla to clean Roudy because taxidermy is his hobby. Elliot tells Turk about Mr. Phillips but the chief of surgery isn't going to accept the surgical risk of a valve replacement on someone who's just going to destroy it with drugs.
J.D. asks around to see who's everybody first kill was on duty and J.D. becomes afraid he will screw up soon. Molly recommends she should go along to the ethics commitee with Elliot to pursuade them to let Mr. Phillips have the surgery. Meanwhile, Mr. Daniels is awaiting his surgery but J.D. suddenly doubts his abilities and claims it is too risky at the moment. Carla loses Roudy on the way home because she left him on the car roof by accident. At the ethics committee, Elliot makes her case and they ask Molly for a professional opinion. Molly tells them Mr. Phillips is not over his addiction. Elliot cancels karaoke even though Molly claims they asked for her professional opinion and couldn't lie.
Dr. Cox confronts J.D. why Mr. Daniels did not have surgery yet. Dr. Cox tells him to do the surgery now. Carla distracts Turk so he doesn't find out about missing Roudy so she tells him to go to a strip club. The Janitor helps Carla to find a new dog but gets sidetracked with hunting a squirrel. Elliot has good news that Mr. Phillips can have the new valve after all but he must come back for rehab over the next 6 weeks following the surgery. He agrees but also mentions he will move down to Florida afterwards.
Molly gets paged from a bragging Elliot who is stil mad about her voting against her at the committee. J.D. needs to do Mr. Daniels' procedure but backs out with another lousy excuse. Dr. Cox tells him Mrs. Carter got killed after he released her without checking her blood cultures three days ago. J.D. is not ready for Mr. Daniel's procudure. The Janitor finds a 1cm shorter stuffed dog he traded with another internet trader for his squirrel army.
J.D. is now relaxed due to him killing somebody before only to see Mrs. Carter in the hospital. Dr. Cox had tricked him, and says fear is good for the job. Elliot is waiting for Mr. Phillips who has missed his last few rehab appointments. Molly joins her and they end up going to the karaoke bar. She suspects that Mr. Phillips has gone down to Florida early.