Someone is vandalizing Christian's possessions, and he attempts to find the culprit. A chemotherapy patient who is considering breast implants brings excitement to Sean's life, and Matt finds himself in a threesome with Vanessa and Riley.

Christian's difficulties with Kristin are exacerbated when his feelings for Julia are revealed. Jude is hired as an intern, to sexy and disastrous results. Matt is caught mid-threesome by Julia.

Matt accidentally hits Cara with Henry's car, and calls Sean in to help when Cara's mother, for religious reasons, refuses drugs and surgery to treat her injuries. Christian discovers that a patient used plastic surgery to hide a revolting crime and it brings up terrible memories of his own childhood.

Sean and Jude's respective secrets are revealed, and Merril offers Christian an interesting trade: Kimber for a Lamborghini. Christian accepts, but Kimber discovers the truth and exacts a small revenge.

Sean and Christian learn that they have to take a test in order to continue practicing. Sean and Megan visit a doctor to learn that there is nothing they can do for her. Mrs. Grubman returns to get an operation on her and her fiancé. Christian passes his test, but Sean walks out. Megan commits suicide. Julia finds out about Sean's affair with Megan.

After Julia's accident in the previous episode, Julia turns to Sean and Christian to fix her face. Sean resists at first, but eventually decides to do it after Christian lies to him and says the woman that was going to fix her face botched several jobs. Sean tells Julia that he keeps trying to forgive her and wants to try to love her again, but that it wouldn't happen right away.

Julia has an adverse reaction to the anesthesia and dreams during her surgery. Ava shows up in her dream as a different form of life coach, and guides her through this surreal life. Julia is married to Christian, which seems happy on the outside, but is really falling apart on the inside. They run the Troy/Troy partnership firm. When Christian decides to leave the practice, Julia interviews another doctor - Sean, someone she knew from high school. Trying to catch up on old times, Sean invites Julia and Christian to dinner. They meet his wife, Megan O'Hara, and their son Matt, who is on the nerdy side and has a bug collection. Megan is three months pregnant with a girl they plan on calling Annie, named after his grandmother. Julia is upset after a visit to Liz, an OB/GYN in this world, who has two kids. Julia cannot have kids with Christian, who wanted to have a biological child since he was adopted. Kimber, Julia and Christian's three-way partner becomes pregnant, and Christian refuses to get rid of it. We are revisited by several characters, including Mrs. Grubman, Jude, and Julia's friend Suzanne.

When Julia wakes up in recovery, Sean is there waiting for her. She has realized that things would never work out with Christian, and that Sean was always the one she loved.

After having a nipple bitten off by her dog, Shari Noble comes in to have it reconstructed before her husband returns from Iraq. Julia meets a breast-feeding expert. Christian and Liz hit a lesbian bar where Christian tries to attract one of the women there but she's attracted to Liz instead. Sean and Christian meet with a kidney specialist for one of their patients.