Dr. Casey's patient complaining because of strange noises. The janitor shows him a roof toilet that makes all the noise. He doesn't understand why people would use a toilet on the roof and the janitor wants to make sure J.D. doesn't tell anyone. Of course, J.D. tells the rest at lunch. Carla & J.D. ask J.D. to be Turk's best man at the wedding.
Dr. Kelso shut down a wing because estimates said there would be less patients coming in at February, but he was wrong. Everybody has been affected by Dr. Casey apart from Elliot who hasn't even been in the spotlight for him. Elliot screws up Mr. Tanaka's procedure and nearly kills him, but Dr. Cox saves the day. J.D. & Turk buy suits for the wedding and J.D. wants to have something that stands out from all the other suits. Elliott is now too scared to do a simply procedure and Dr. Cox needs to do it for her. Dr. Kelso admits his gardener Hector and orders Dr. Cox to look after him even though they have no free beds. The janitor asks J.D. if he had told anybody about his toilet. Ted just comes from the roof and we also see Dr. Cox sitting on it. It gives him the idea of placing Hector into Bob's office.
Elliot knows she needs help and Dr. Casey introduces himself to her. J.D. comes home and checks his messages to find out that he was only second choice after Turk's older brother and that he can be the best man after all. J.D. pays Turk back by screwing up the measurements for his suit and advices Turk to tell Carla about his ideas for the wedding, even though he knows that the wedding is all about what the woman wants. Carla is crying to hear about Turk's complaints. Elliot and Kevin are at lunch in the cafeteria. They are flirting a little and he asks if she has been to the roof toilet, but she hasn't as she prefers extra locks on the door.
Dr. Kelso finds it unacceptable that his gardener is still in his roof. There is a huge line for the roof toilet and the janitor wants to make sure that nobody else finds out. Turk needs to talk to J.D. and he thinks this is about the best man position so he makes excuses to get away. Elliot explains that she needs to get over her problem or it might end her carreer. Dr. Casey promises to help her out like he did with everybody else. J.D. uses the roof toilet and has an epiphany
so he goes to find Turk. While searching he sees Dr. Casey who has to return to his old hospital. Elliot is looking for Kevin, the only person he hasn't helped yet. J.D. is still looking for Turk and finds Elliott all sad in the cafeteria. He tells her that Kevin didn't help all people in the hospital and that she can just tell her problem to him instead. Just as she starts, J.D. sees Turk and rushes off. Dr. Kelso and Carla pursuade Dr. Kelso to open up the wing again and he does so, helping out the space problem once and for all. Elliot finds a rolled out roll of toilet paper at her locker that says "Follow me" and she starts collecting the roll all the way through the hospital, up the stairs and out the door to the roof. The paper roll ends at the toilet and there is a picture of Dr. Casey finally managing to sit on it himself. Now it's Elliot's turn. J.D. admits he heard the message on his machine. Turk reveals he had only asked his brother to be best man, thinking that he wouldn't have time anyway and have to decline it. Now Turk is screwed because his plan has changed and his brother is all excited, but J.D. was still his first choice all along. J.D. offers to be co-best man and Turk is reliefed. Dr. Cox and Carla wonder if there is another side to Dr. Kelso's life they don't know about, where he is much nicer than at the hospital. They ask him, but he replies it isn't any of their damn business.
Elliot finally sits on the floor toilet but doesn't get any epiphany. Then suddenly the emergency helicopter arrives and carry out a patient who needs to be intubated as they are running out of time. Elliot needs to do it and does it right under pressure. Dr. Casey turns out to be one of the paramedics and tells her this is why he wanted her to use the toilet up here. He kisses her but then Elliott wakes up from her fantasy. She gets up all confident.
The next day, J.D. & Turk discover that the roof toilet is gone, Dr. Kelso drives away with Hector and his family, Elliot got her intubation skill back, J.D. finds the janitor with the toilet in a storage room and bumps into a doctor who drops all his files on the floor. Everything is back to normal.