J.D. mistakes an elderly woman's happiness as her wish to stop treatment for a fatal illness. Turk and Elliot struggle to find the cause of a patient's body pain and Carla tries to organize the annual group photo.
- Brick Joke: Janitor threatens to give the Todd a four story atomic wedgie if he tries to get in his roof tub. Several scenes later, he does exactly that and we get to see Todd dangling from the roof from the inside of the hospital.
- The Cameo: Gary Busey shows up for a quick joke that just barely nets him an over five.
- Character Development: Although it's because of poor communication, JD's willing to accept that his patient is ready to die, whereas in "My Old Lady" he spent hours of his free time trying to convince a patient to live.
- Creator Cameo: Bill Lawrence can briefly be seen lying on the ground wearing scrubs in the front of the staff photo at the end of the episode.
- Didn't Think This Through: When Turk and Elliot realize their patient's wife is about to chew them out for discharging her husband due to them not finding anything that could explain his pain, Turk suggests that whoever chugs their slushie down first won't talk to her. He immediately gets brain freeze.
- Poor Communication Kills: Because JD doesn't directly ask and his patient doesn't directly say it (and he interrupts her), he mistakenly believes she's ready to die.
- Running Gag: Todd shows up to every staff photo in a banana hammock.
- Shout-Out: JD's Imagine Spot regarding exploratory surgery is an homage to the opening of Indiana Jones and the Temple of Doom.
- Too Kinky to Torture: When J.D. talks about pain differing for people with different race, gender, and sex drive, he uses a man getting turned on by someone taking a ring out of his face as an example.
- What the Hell, Hero?: Carla and Janitor trade these after he ruins the staff photo with his little mirror.Carla: Why would you ruin this for me? I mean, I didn't even ask you to be there?
Janitor: Imagine that. I've been working here thirteen years and I guess I don't rate as part of the family.
Carla: Did you want to be in the picture?
Janitor: No! I it's uh p... I gotta go.
