It's conjugal visiting day at the prison and since no one is visiting Earl, Frank wants Earl to explain to his girlfriend why he cannot see her today. Things don't go as planned and Frank's girlfriend dumps him because of Earl. Earl is blames himself and vows to get them back together.

Earl is having difficulty re-adjusting to life on the outside. He returns to his old ways after he encounters Ralph. Randy plans an intervention for Earl on Christmas morning.

After a car accident Earl is put in a coma and finds himself in an alternate world shown as a sitcom, while his friends try to keep him alive.

Nothing can get Earl out of his coma, so Randy turns to a young faith healer from their past. However, the boy says that he no longer heals people because he discovered how Earl lived his life after he "healed" him the first time.

While Earl is still in a coma, Randy starts to believe that he can help Earl get better by crossing things off the list.

When the hospital wants to get rid of Earl, Randy decides to take care of his brother by himself. But instead of working on the list for Earl, he uses Earl's help to cross things off in order to help him get better.

When Earl finally wakes up from his coma, he believes in Karma again and considers Billie his soul mate.

Inspired by Earl, Billie starts a list of her own and when Earl is getting annoyed by Billie's little habits, he decides to focus on working on the list instead. He picks a task that is on both of their lists, atones for the injury of a champion grocery-bagger and discovers a unique talent of his own. But Earl soon finds out that they have different ways of interpreting Karma.

When Earl finds out that making up for all the bad things he did to women changes Billie's behavior to the good, he picks the worst thing he ever did to women on his list. Billie wants him to choose between her and his list. When he picks the list, she steals it and starts undoing the items he has already accomplished.