The Janitor installs a toilet on the roof to help him think. He claims that it inspires epiphanies. While J.D. keeps it a secret, word soon gets out. The whole hospital staff starts lining up to use it for insights into their problems. Dr. Kevin Casey, who is still visiting, becomes fascinated and grossed out by it at the same time.
Elliott undergoes a Heroic BSoD and crisis of confidence when Dr. Cox observes that she's intubated a patient incorrectly and nearly killed him. She goes to Dr. Casey for help.
Now that wedding prep is in full swing, J.D. prepares to do right by Turk as his best man. A chance voicemail from Turk's brother, however, reveals that J.D. was actually the second-choice. Jealousy starts to fuel his actions.
Tropes for this episode include:
- "Could Have Avoided This!" Plot: J.D. finally admits that he was jealous that he wasn't Turk's first-choice. Turk tells J.D. that J.D. always was his first choice; he only asked his brother out of family obligation, knowing that his brother couldn't make it to the wedding. He tells J.D. to come to him next time.
- Face Your Fears: Dr. Casey drums up the courage to use the toilet seat on the roof, despite his logical objections that it's probably not hygienic. Elliott sees him going through circles, and eventually he takes a Polaroid of himself using it.
- Here We Go Again!: The episode ends with the janitor moving the toilet to one of his closets. He gestures at J.D. to keep mum about it.
- Maybe Magic, Maybe Mundane: Maybe the toilet actually works, or perhaps it doesn't. Most of the epiphanies that people have are either simple solutions or answers that come from deep down.
- O.O.C. Is Serious Business: Elliott has a surprised look on her face when a string of toilet paper leads her to the toilet on the roof and a photograph that Dr. Casey took of himself using it. She knows that his OCD and mysophobia are bad. Yet he was able to face his comfort zone and step out of it.
- Put on a Bus: Dr. Casey's time at Sacred Heart ends, and he admits that he wasn't going to stay forever. Even so, he leaves a parting gift for Elliott to help her get her confidence back.
- Ship Tease: Elliott's dream hints that she has a crush on Dr. Kevin Casey, given it ends with them making out.
- The Tape Knew You Would Say That: In a sense. When looking at the polaroid of Kevin proudly sitting on the toilet, Elliott wonders aloud how he took it. The back of the photo says it was taken with a self-timer.
