J.D.'s teenage burn patient gives him a hard decision to make when he wants to go to his high school graduation. Turk doesn't want Carla to find out that he secretly learned Spanish. And to address Dr. Kelso's weight gain, Dr. Cox makes a game out of stealing his breakfast.

When Dr. Kelso tells the Janitor that nobody cares what he thinks, he starts a newspaper called "The Janitorial" to prove him wrong. J.D. and Turk fight over their manhood issues, while Dr. Kelso is too proud to ask for help about one of his problems.

Elliot and J.D. discover a major change in their relationship, when they spend time together looking for a former patient.

Dr. Cox contemplates his new job title, when Ted refuses to do the majority of his work, whilst Carla and Turk talk about the possibility of a second baby. Meanwhile, the Janitor claims Dr. Kelso's abandoned office for the brain trust.

Dr. Kelso's beautiful but unethical replacement, Dr. Maddox, shakes things up at Sacred Heart, while J.D. struggles to manage a new crop of incompetent interns and Carla helps Elliott put her ego in check.